ABSTRACT
Abstract Introduction: Physiological responses to hemorrhage are not proportional to blood loss. This has led to the use of scores such as the shock index (SI) or biomarkers such as lactate clearance (LC) and base deficit (BD) in the assessment of multiple trauma patients. Objective: To determine the risk between no LC, persistence of BD, and severe SI at 6 hours, and postoperative morbidity and mortality. Methods: Prospective cohort study with multiple trauma patients taken to surgery. SI, BD, and lactate levels were calculated on admission and after 6hours; LC was estimated at 6 hours; and follow-up was performed after 28 days to determine morbidity and mortality. Inadequate LC was defined as <20% at 6hours, severe SI as >1, and abnormal BD as <-6 mmol/L. Results: Overall, 196 patients were assessed. Morbidity and mortality were 46.24% and 19.69%, respectively. Relative risks for morbidity such as surgical reintervention, acute renal injury (ARI), pneumonia, need for vasopressors, and transfusions were significant for LC < 20%. Severe SI and BD on admission were not found to be significant predictors, but after 6 hours, their behavior was similar to that of LC. In the final model, the significant variables for mortality were LC < 20% at 6 hours, ARI, age >45 years, suture dehiscence, transfusions. Conclusion: In multiple trauma patients in shock, low LC, severe SI, and persistent BD at 6 hours were significant for morbidity and mortality and their use as follow-up markers should be encouraged in resuscitation therapies for patients in shock.
Resumen Introducción: Las respuestas fisiológicas a la hemorragia no son proporcionales a la pérdida de sangre, lo cual ha llevado a usar escalas como el índice de choque (IC) o biomarcadores como la depuración de lactato (DL) y déficit de base (DB) en la evaluación del paciente politraumatizado. Objetivo: Determinar el riesgo entre no DL, persistencia DB e IC severo a las 6 horas y morbimortalidad postquirurgica. Métodos: Se realizó un estudio tipo cohorte prospectiva de pacientes politraumatizados, intervenidos quirúrgicamente. Se calculó DL a las 6 horas; el IC, DBEx y lactato al ingreso y control a las 6 horas; se realizó seguimiento a 28 días para determinar morbilidad y mortalidad. DLa inadecuado se definió como <20% a las 6 horas, IC severo:>1 y DB anormal:<-6mmol/L. Resultados: Evaluamos 196 pacientes. La morbilidad fue del 46.24% y la mortalidad del 19,69%. Los RR para morbilidad como reintervención quirúrgica, injuria renal aguda (IRA), neumonía, requerimientos de vasopresor y transfusiones fueron significativos para DL<20%. El ICs y el DB severo al ingreso no fueron predictores significativos, pero a las 6 horas presentaron un comportamiento similar a la DL. En el modelo final, las variables significativas para mortalidad fueron: DL<20% en 6horas, IRA, edad >45 años, dehiscencia, transfusiones. Conclusiones: En pacientes politraumatizados en estado de choque, la baja DL, el IC y DB severo persistente, a las seis horas, fueron significativos para morbimortalidad y deben promoverse como marcadores de seguimiento en las terapias de reanimación en choque.